Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence
Open accessAbstract
IMPORTANCE: Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. OBJECTIVE: To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTS: Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE: Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURES: Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). RESULTS: Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. CONCLUSIONS AND RELEVANCE: Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.
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Several longitudinal studies found that electronic cigarette use at baseline is associated with increased risk of later combustible tobacco use.
“Several longitudinal studies have found that electronic cigarette use at baseline is associated with increased risk of future use of combustible tobacco products.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [10]
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- Authors
- Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., Stone, M. D., Khoddam, R., Samet, J. M., & Audrain-McGovern, J.
- Affiliations
- University of Southern California (US)
- University of California San Diego (US)
- Colorado State University (US)
- University of Pennsylvania (US)
- Corresponding author
- Leventhal, Adam M.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-08-18
- Volume
- 314
- Issue
- 7
- Pages
- 700
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4771179
- OpenAlex
- W1824236177
- Cited by
- 913
- References
- 5
- Citations by year
- 2026: 29 · 2025: 32 · 2024: 44 · 2023: 50 · 2022: 62 · 2021: 78 · 2020: 105 · 2019: 129 · 2018: 111 · 2017: 118 · 2016: 127 · 2015: 23 · 2014: 1
- FWCI
- 93.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01DA033296, R01DA026831, F31DA039708)
- National Cancer Institute (P50CA180905)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- electronic cigarettes, adolescent smoking, never smokers, hookah, cigars, cigarettes, nicotine exposure, adolescent tobacco use, school-based cohort, tobacco product use
- MeSH terms
- Adolescent, Adolescent Behavior, Data Collection, Female, Follow-Up Studies, Ganglionic Stimulants, Humans, Male, Nicotine, Risk Factors, Smoking, Students, Los Angeles, Odds Ratio, Self Report, Tobacco Products, Electronic Nicotine Delivery Systems
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